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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209420
Report Date: 05/08/2024
Date Signed: 05/10/2024 09:30:40 AM


Document Has Been Signed on 05/10/2024 09:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:JADE CARE HOMESFACILITY NUMBER:
107209420
ADMINISTRATOR:ESTEBAN, SALLYFACILITY TYPE:
740
ADDRESS:8561 N. CALAVERAS STREETTELEPHONE:
(626) 420-5748
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 0DATE:
05/08/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Licensee, Jerome EstebanTIME COMPLETED:
09:58 AM
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On 5/8/2024 Licensing Program Analyst (LPA) M. Garza arrived to complete an announced pre-licensing visit. LPA met with Licensee, Jerome Esteban. LPA was permitted entry into the facility.

This visit is being conducted as a follow up visit. Corrections were needed in order for the facility to be licensed. The following issues were observed during the last visit: non-skid mats missing from bathrooms and visiting/complaint policy postings missing.

LPA toured the facility and observed the restrooms with non-skid mats. Visiting and complaint postings were observed posted in entry way of the facility.

The corrections have been made as required.The Component III was conducted with Licensee during 5/6/24 visit. LPA will send notification that facility is ready to be licensed. Exit interview completed with Licensee, Jerome. A copy of this report was provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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